Single Payer Healthcare

[MachineGhost]

The thing is, it's not just the FDA choking off competition. There's also the laws preventing CMS (the agency overseeing Medicaid and Medicare) from negotiating drug prices, and those making it illegal for you to buy medications from Canadian or overseas pharmacies.

Huh, I thought the inability to negotiate drug prices was rescinded in some legislation recently?

[MachineGhost]

I've racked my brain for a reason why a single risk pool (ala Medicare) is a beneficial thing. Does it boil down to policymakers wanting to hide the true costs of the medical welfare state?

Don't be so paranoid. It's nothing to do with hiding costs but the economics of the situation known as the "adverse selection" problem:

Pre-Obamacare: Insurance refuses to cover pre-existing or drops coverage after filing a claim.
Post-Obamacare: Insurance pulls out of the state and its risk pool.

The only thing that is different in either case is who gets hurt. In the first, its the patient. In the second, its both the insurance company and the patient.

[MachineGhost]

What I'm really asking is this: If you intend to provide medical benefits to the uninsurable and to those who cannot afford insurance, why not simply do that in an above-board way--i.e., by way of a medical welfare program? By separating this out and calling it what it is, society can begin to make informed decisions about the kind of money it's willing to throw at the support of public health care, what kinds of interventions it's willing to pay for, and what it's going to require from beneficiaries in the way of responsibility for their own health status. It seems like insisting that everybody be part of the same risk pool is a convenient way to keep from having to confront the reality of how rapidly resources are being consumed by people who are contributing very little to the system and who, in many cases, are taking very little responsibility for their own health.

And now I say: Don't be such a Republican! Whether it is a private insurance pool or public medical welfare pool, it's all about socializing the costs among as many people as possible so the impact on any one individual is not devestating. True, it shouldn't be for non-catastrophibic costs, but I'm not the one that made that decision for the country (I think it was Ted "Fat Fuck" Kennedy back in the 1960's).

Medicaid & Medicare more or less operate in the way you envision. They're not 100% transparent, but then they're not democratic institutions either.

[MachineGhost]

This.
Why should we pay more because other people are irresponsible?
[That comment brings back memories of the 2008 mortgage bailout. grrr]

Because we don't want to live in a world where the mass poor and unfortunate aren't taken care of, like Brazil? They also won't have the money or welfare benefits to pay for your dental services which means you wouldn't have such a high falutin' career as a upper middle class professional. So be careful what you wish for. Comparative advantage works with socio-economics too, not just trade.

[Kbg]

I've racked my brain for a reason why a single risk pool (ala Medicare) is a beneficial thing. Does it boil down to policymakers wanting to hide the true costs of the medical welfare state?

Healthcare is unlike any other consumer item and you can't think of it like a bushel of wheat. Morality and macro economics are major factors influencing it.

Assuming as a society you have the option due to your relative wealth, is a medical welfare state intrinsically a bad thing? Obviously there could be some efficiency issues; however, do the rich folk get all the transplant hearts and livers out there because they have a greater ability to pay? Should a child who gets Type I diabetes be screwed financially for the rest of their life because no one will insure him/her?

Assuming you are wildly rich, is there a problem for society if you spend $20 million of your own $$$ on extending your life for six months assuming a government entity living off of taxes isn't paying for it? What if government is paying for it?

Should a bio medical company have exclusive rights for the next 1000 years because they came up with "the" cure for cancer and can price it anyway they want?

Obama care is classic Washington DC. Personally I have zero problem with forcing insurance companies to cover pre-existing conditions; however, allowing people to opt out for a $500 tax fine was ridiculously stupid. If you want competition, then let medicare management directly compete with the Big 5 insurance companies management and let's see who truly can do it cheaper gainst a given set of cost and performance standards. And if "rationing health care" is a major deal then force insurance companies and medicare to eliminate any and all treatment reviews above doctor level. Anyone really think a single insurance company out there is going to sign up for that?

Lastly, if we want people to be more price conscious what is in it for them? Many years ago we were in an insurance company that incentivized us with cash in our pockets for my wife to leave the hospital with a no complications involved proviso (birth delivery). Basically you went from getting quite a bit, to nothing, to paying out of pocket over a period of four days. We were poor grad students, no complications and left at the max benefit financially to us. What if you got to split the difference on brand name vs. generic medications? Think behavior would change?

But here's the dirty reality...insurance cos, hospitals, docs and the whole medical system get paid for us to use them as much as possible. Order up a test...better legal protection and a cut of the test fee for everyone in between. More tests please!

I don't think bringing health care costs down is all that difficult in many areas if the consumer actually got the benefit of making smart price choices directly, but they don't and no one on the provision side has any real incentive to be faster, better, more efficient.

So...morality is involved; therefore, most people would reject a purely economic solution. Incentivizing consumers to be cost conscious would help in many areas, but the suppliers have no real incentive to enable such a system as it would hack into how they collect fees/premiums. "We" have exactly the system "we" want. I do believe it is getting to the point though that the current system is going to break and real innovation may occur...whether I will see it in my lifetime IDK, but I think it is coming.

[Kbg]

Nobody said the poor or unfortunate should not be cared for, I said people [both rich and poor] should take some financial hit for their irresponsibility, just like with car insurance and homeowner's insurance.

Totally agree, you smoke you pay way higher insurance premiums than non-smokers. Disincentivizing stupidity would also bring down costs. On the flip side, you shouldn't get penalized or tracked for stuff that is genetic/not of your own willful choosing. Just that which you can control and after a certain age.

[WiseOne]

I imagine one benefit is that it avoids some people being so "risky" as to be uninsurable, which was a major complaint about the pre-Obamacare system.

What I'm really asking is this: If you intend to provide medical benefits to the uninsurable and to those who cannot afford insurance, why not simply do that in an above-board way--i.e., by way of a medical welfare program?

We have that medical welfare program already. It's called Medicaid for low-income people under 65, and Medicare for people over 65. There are certain qualifying conditions, e.g. diabetes, that will get people coverage who otherwise don't meet the requirements. Most of the people in these programs are high risk and thus uninsurable.

The for-profit insurance industry is mainly for people who are well. It's an absurd way to divide risk. That may be the issue with Obamacare: the Obama administration mistook the private insurance system as providing comprehensive health insurance. It doesn't. It provides coverage mainly for routine costs, or rare sudden catastrophic medical problems that occur in the well population - at least until the insurer can find a way to cancel or deny coverage. And they are VERY good at doing that.

Putting everyone into a single risk pool and letting current insurance companies administer coverage is a great way to go. I like that Swiss system. Of course, one problem we have that they don't: tons of "new immigrants" who need healthcare but can't pay for it. Go look for your nearest Medicaid hospital and check out the outpatient clinic waiting rooms. Count the proportion of Hispanics. I guarantee that it'll be at least 95% of the clinic population, and you'll hear far more Spanish spoken than English.

[Tyler]

The for-profit insurance industry is mainly for people who are well. It's an absurd way to divide risk. That may be the issue with Obamacare: the Obama administration mistook the private insurance system as providing comprehensive health insurance. It doesn't. It provides coverage mainly for routine costs, or rare sudden catastrophic medical problems that occur in the well population - at least until the insurer can find a way to cancel or deny coverage. And they are VERY good at doing that.

Well said. And much more succinctly than my feeble attempt.

When there are so many mechanisms built in for insurance companies to cancel or deny coverage, it's not really insurance anyway. It's just a money transfer system from well people who are discarded as quickly as possible once they ask for something in return.

[Kbg]

IIRC, the Freakonomics podcast did an episode on how health insurance ended up becoming a company thing in the US. Apparently it happened during or shortly after WW2 when price and wage freezes were in effect. Companies started offering H.insurance as a way to get around the wage freeze and eventually it stuck as a compensation tool.

I'm starting to come around to single payer if we are going to require insurance for everyone. I've a couple of friends who live in the UK and Canada and they all compliment care availability in the US as compared to their locations so whatever we are doing in that respect seems to be better than govt. controlled medicine. Perhaps Medicare and the military's Tricare is an in between solution. Where you get some bargaining power with Uncle Sam via competitive contracts but the private sector still does the actual running of it.

For sure, this is a complex topic.

[MachineGhost]

A not uncommon site for me here in upper east Tennessee is a morbidly obese middled aged white person tooling around Walmart on a motorized wheelchair, attached to an oxygen tank. He likely smoked and ate his way to that condition. I don't look at such a person and think "boy, she's got is made" or "I bet that freeloader didn't have to pay for any of that". I think "holy crap, his life must be awful... can't even walk on his own. Can't breathe the air I breathe."

That's interesting because when I see people like that, I: a) feel pity and melanchonly; b) think to myself what a fucking loser for being so ignorantly stupid beyond the pale; c) feel annoyed that they're imposing their problems onto the public both in the need to avoid their fat ass scooter, accomodate them sickcare wise and pay for their expenses via taxes.

I know it is an elitist behavior but when one walks the talk and so many others do not, what else could the outcome be?

All I know is the current model is broken and completely disincentivizes prevention. There is no pressure to be self-responsible other than narcissim. Fat people hang around fat people. Well people hang around well people. It's a huge self-reinforcing social problem. It's actually a nightmare but its such the norm now all you can do is just shrug.

[MachineGhost]

Go look for your nearest Medicaid hospital and check out the outpatient clinic waiting rooms. Count the proportion of Hispanics. I guarantee that it'll be at least 95% of the clinic population, and you'll hear far more Spanish spoken than English.

Aye, that is true in SoCal. And to a certain extent in emergency rooms also. Those places should only be a "lender of last resort" for people not in the socio-economic class they are designed for.

[MachineGhost]

For sure, this is a complex topic.

It's not a big leap to go from Medicare For All single payer to Medicare For All consumer-driven , but how politically feasible is that? We're proposing a Trumpism of both politics and the insurance industry. Don't hold your breath. In the USA, profits always matter more than doing what is just and fair.

[Maddy]

. . .for people not in the socio-economic class they are designed for.

Priceless.

[MachineGhost]

The most expensive drug in history is a money loser that’s not reaching patients. In fact, it’s only been paid for and used commercially once since being approved in 2012.

The medication in question is alipogene tiparvovec, better known as Glybera, a medicine widely heralded as the “first gene therapy” in the Western world and whose approval helped ignite an explosion of investment and excitement around treatments that correct DNA.

But when the Berlin physician Elisabeth Steinhagen-Thiessen wanted to give a patient Glybera last fall, it wasn't so easy. She says she had to prepare a submission as thick as “a thesis” for German regulators and then personally call the CEO of DAK, one of Germany’s large sickness funds, or insurers, to ask him to pay the $1 million price tag.

Last September, she gave 40 injections to the muscles of a 43-year-old woman with an ultra-rare disease called lipoprotein lipase deficiency. Such patients don’t process fat correctly. “You draw blood and you are astonished, there is no red blood, it's cream,” Steinhagen-Thiessen says. One symptom is debilitating abdominal pain. Her patient had been hospitalized more than 40 times.

A dose of Glybera contains trillions of viruses harboring correct copies of the lipoprotein lipase gene. And Steinhagen-Thiessen says the treatment, at Charite Hospital in Berlin, was a success. The woman hasn’t been back to the emergency room since the treatment and is now “living like you and me.”

But this single use of the drug just proves that Glybera is a flop. The problem is its staggering million-dollar price tag, too few patients, and questions about how effective it is.

https://www.technologyreview.com/s/6011 ... is-a-bust/

[Maddy]

Glybera??? Who thinks up these names? Ever noticed how the really high-tech stuff that makes your hair and teeth fall out has really scary names? Nivolamab. Pimbrolizumab. Timsirolimus. Tofacitinib. The brand names aren't always much better (Xeljanz). If somebody came at me with a syringe full of that stuff, I'd be hiding under the bed.

The drug makers should take a clue from the erectile dysfunction crowd and call their drugs something HAPPY. How about Ecstatis? Or Energia? Exhiladrine?

[curlew]

Glybera??? Who thinks up these names? Ever noticed how the really high-tech stuff that makes your hair and teeth fall out has really scary names? Nivolamab. Pimbrolizumab. Timsirolimus. Tofacitinib. The brand names aren't always much better (Xeljanz). If somebody came at me with a syringe full of that stuff, I'd be hiding under the bed.

The drug makers should take a clue from the erectile dysfunction crowd and call their drugs something HAPPY. How about Ecstatis? Or Energia? Exhiladrine?

I used to think those funny names for pharmaceuticals came from a bunch of marketing people dreaming up cool sounding names but there actually are standards for naming drugs, at least until it gets to the selection of the trade name by which it is marketed....

http://www.popsci.com/science/article/2 ... t-its-name

[curlew]

I thought this cartoon about ObamaCare was priceless....

[MachineGhost]

[Pointedstick]

The devil's advocate in me can't help but observe that there appears to be an extremely strong correlation between the ill-served states and the states whose political leadership have been fighting Obamacare since day one.

[Mountaineer]

The devil's advocate in me can't help but observe that there appears to be an extremely strong correlation between the ill-served states and the states whose political leadership have been fighting Obamacare since day one.

But that implies obama and his cronies are vindictive ......... surely not! Another bubble burst.

... Mountaineer

[Pointedstick]

My implication was more along the lines that the states that fought it have probably been partially responsible for it not working as well there.

Not that I'm a fan of Obamacare at all, mind you. But, duh, if you fight against something, it's not gonna work as well as if you had embraced it or been neutral.

[Maddy]

My implication was more along the lines that the states that fought it have probably been partially responsible for it not working as well there.

Or they were right, and it didn't work well there.

What particular factors make a county a profitable place for a health insurer? I think I'd be looking more along the lines of demographics for an explanation.

[Pointedstick]

What particular factors make a county a profitable place for a health insurer? I think I'd be looking more along the lines of demographics for an explanation.

For a start, probably a lot of healthy and wealthy people. If that's part of the explanation, it makes a certain amount of sense since the red states tend to be poorer and less healthy than the blue states. Still, it's not a perfect explanation since my own state of New Mexico is extremely poor and unhealthy, but that map says there are plenty of options here.

[WiseOne]

Interesting. I think there's a process to qualify for Obamacare that requires some input from the state. A bigger barrier, though, is the need to change existing policies to conform to Obamacare guidelines. Remember all those insurance cancellations of policies that didn't fit the new requirements? Insurers may have been unwilling to do that in these states, because it wouldn't at all be clear that the cancelled policyholders would then sign up for new (and more expensive) Obamacare policies.

As far as New Mexico, though, the majority of the population with the health issues is Navajo, and they're covered separately. Sort of like Medicaid but with no means testing. They were given the option to sign up for Obamacare, but I highly doubt many of them did so.

[Pointedstick]

As far as New Mexico, though, the majority of the population with the health issues is Navajo, and they're covered separately. Sort of like Medicaid but with no means testing. They were given the option to sign up for Obamacare, but I highly doubt many of them did so.

Interesting. You're right about their health, though. Incredibly high rates of alcoholism, domestic violence, and child abuse, too. If the Native community didn't exist, New Mexico would probably score a lot higher on pretty much everything.